| NPI | 1558650853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 15436) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 007499) |
| 183500000X Pharmacist (Licence: ME PR6377) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2012-09-05 |